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Early disease manifestations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Around 50-70% of patients are aware of the bite which begins as a red macule or papule at the site of tick bite, most commonly in the groin, the thigh and the axilla.

  • occurs at a median of 21 days (range 3–32 days) following a tick bite
  • subsequently this lesion expands into ‘target-like’ rash of erythema migrans (EM)
    • is the commonest clinical manifestation of Lyme disease and is seen in around 60%–90% of cases
    • although EM is classically described as having a bull’s eye appearance, around two thirds of single erythema migrans lesions either are uniformly erythematous or have enhanced central erythema without clearing around it
    • common sites include: the groin, axilla, waist, back, legs, and, in children, the head and neck (may occur anywhere on the body surface)
    • may be asymptomatic, mildly pruritic, or, in rare cases, painful
    • if untreated, lesions may become 61 cm (2 ft) in diameter or larger and may last for 3 to 4 weeks before resolving (1,2)

Assocaited non-specific constitutional symptoms are more likely to be seen in infections acquired in North America (3):

  • fever and headache
  • chills
  • stiff neck
  • arthralgia and myalgia
  • lymphadenopathy
  • lethargy and fatigue
  • hepatomegaly

Atypical symptoms may be present infrequently

  • respiratory symptoms - cough or rhinorrhea
  • gastrointestinal symptoms - vomiting or diarrhoea (2)

With or without treatment these initial clinical manifestations resolve within 3 to 4 weeks although the dermatologic manifestations may recur (2).

Reference:


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